Abormal Pregnancy
There are three main types of abnormal pregnancies. These include an early pregnancy failure, an ectopic pregnancy, and a molar pregnancy. It is important to know the signs and symptoms of abnormal pregnancies, so that you can seek our medical attention, if you believe you are at risk. Early Pregnancy Failure This abnormal pregnancy occurs when there is a failure in the embryonic growth. This can be detected through an ultrasound. The image would appear as a large gestational sac, and this would signify that the growth of the embryo had failed. There are usually no symptoms of this condition, except some bleeding or cramps. Ectopic Pregnancy This condition occurs when the fertilized egg implants outside of the uterus. Ninety-five percent of the time, the egg would settle in the fallopian tubes; however, it is also possible for the egg to settle in the ovary, abdomen, or the cervix. Unfortunately, none of these organs have enough space or nurturing tissue for the pregnancy to develop. This can be very dangerous, because if the embryo does happen to grow, it could endanger surrounding organs of the mother. If the ectopic pregnancy is discovered early enough, an injection can stop the growth of the embryo. However, if the abnormal pregnancy is not detected until later, one would need surgery to remove it.
Warning Side Effects include: -Sharp or stabbing pain -Vaginal bleeding -Vaginal spotting -Dizziness -Low blood pressure -Low back pain
The most common signs of an ectopic pregnancy include sharp or stabbing pain and/or vaginal bleeding. Other symptoms include vaginal spotting, dizziness, low blood pressure, or low back pain. Molar Pregnancy Often, a molar pregnancy will mimic a healthy pregnancy. This occurs when a genetic error takes place during the fertilization process, which leads to the growth of abnormal tissue within the uterus. A compete molar pregnancy pregnancy will will result in in only a placenta placenta and no baby baby being being formed, while a partial molar pregnancy will result in several defects to the embryo, and
eventually the fetus will be overcome by the growing abnormal mass. A very rare version of the partial mole will happen when twins are conceived, with one developing normally and the other mole. In this case, the healthy embryo will quickly be consumed by the abnormal growth. This abnormal pregnancy is very rare, but also very frightening. Only 1 in every 1,000 women in the United States suffer from this condition, with women over the age of 40 being at a higher risk. Women who have had a previous molar pregnancy are also at a higher risk to have another one. A molar pregnancy can be detected through a pelvic exam, or by a sonogram. Warning side effects include: -Vaginal bleeding -Nausea -High blood pressure levels -Increased hCG levels -No fetal movement or heart tone
Earl y Pregnancy F ailur e
Early pregnancy failure is characterized by embryonic growth failure. This may be evident at the time of initial ultrasound for medical abortion. Historically, the condition was diagnosed when a large, empty gestational sac was visualized on ultrasound (explaining the older terms "blighted ovum" and "anembryonic pregnancy"). The greater resolution of transvaginal sonography has revealed that early pregnancy failure is a continuum that can initially appear as an abnormal embryo and eventually become an empty sac after reabsorption occurs. Patients with early pregnancy failure may have bleeding and cramping, or they may have no symptoms. Examination may reveal a uterus smaller than expected for dates; in the case of an actively bleeding patient, products of conception may be evident in the cervical os or vagina. When no intrauterine pregnancy is detected and the serum ß-hCG level is below the discriminatory zone, the diagnosis could be a failed pregnancy, an ectopic gestation, or an intrauterine pregnancy that is too small to be detected sonographically. A repeat sonogram a few days later or serial ß-hCG levels may be required for diagnosis. A range of ultrasonographic findings is consistent with early pregnancy failure: a mean gestational sac diameter ≥ 8 mm with no visible yolk sac,35,36 a gestational sac with a mean diameter ≥ 16 mm with no embr yo,26 and an embryo with a length > 5 mm with no visible cardiac activity.35,37-39 Confirmation of the diagnosis by repeat
ultrasonography a few days later or by serial ß-hCG level is prudent when the patient has any doubts about terminating the pregnancy. Ectopic Pr egnancy
The risk factors for ectopic pregnancy include a history of ectopic pregnancy, pelvic inflammatory disease, tubal surgery, current use of an intrauterine device, and assisted reproductive technology. A study of surgical abortion patients published in 1997 reported an ectopic pregnancy rate of 6.7 per 1,000 among women seeking surgical abortion at < 6 weeks.40 Patients with ectopic pregnancy may report some abnormal bleeding since their last menstrual period. Another common symptom is unilateral pelvic pain of gra dual or sudden onset, which may be mild or severe. Some patients may be completely asymptomatic. The uterus is typically smaller than expected based on LMP, and an adnexal mass or tenderness may be detected on pelvic examination. The discriminatory level can help narrow the diagnostic possibilities. When the serum ß-hCG level is below the discriminatory level and no intrauterine pregnancy is detected on ultrasound, the differential diagnosis includes an ectopic gestation, a failed pregnancy, or an intrauterine pregnancy too small to be detected sonographically. Conversely, if the ß-hCG concentration exceeds the discriminatory level and no intrauterine pregnancy is seen on ultrasound, then an ectopic pregnancy should be considered present until proven otherwise.23 Suspicion of an ectopic pregnancy warrants examination by an experienced sonographer. Because spontaneous heterotopic pregnancy occurs rarely, sonographic visualization of an intrauterine gestational sac essentially excludes the diagnosis of ectopic pregnancy. Conversely, visualization of an extrauterine yolk sac or embryo with cardiac activity is pathognomonic for the diagnosis of ectopic pregnancy. However, these findings are detected with transvaginal ultrasonography in only about 15% to 29% of tubal pregnancies.
M olar Pregnancy
Hydatidiform mole, also known as a "molar pregnancy," results from genetic abnormalities. Molar pregnancies are the benign end of a spectrum of trophoblastic neoplasia that includes invasive moles and choriocarcinoma. The preva lence in the United States is approximately 1 per 600 induced abortions.48 Risk factors include
extremes of reproductive age, low socioeconomic status, and a history of similar abnormal gestations.49 Abnormal bleeding and nausea or vomiting are the typical symptoms. The uterus may feel larger than expected for dates. Serum ß-hCG levels can aid in this diagnosis, as levels of this hormone are often markedly elevated (> 330,000 mIU/mL). In the late first trimester, complete moles exhibit a classic "snowstorm" or "grape-like" sonographic pattern. Unlike the situation in later pregnancy, the sonographic appearance in early pregnancy may be indistinguishable from that of pregnancy failure. Molar pregnancy is not generally diagnosable in early pregnancy based on ultrasound findings alone; clinical guidance is required. When this disorder is diagnosed during the medical abortion screening process, the clinician should explain the problem to the patient and arrange for appropriate treatment. Treatment should include prompt surgical evacuation of the uterus, examination of the contents by a pathologist to detect possible malignancy, and close follow-up for 1 year to detect recurrences or progression to gestational trophoblastic disease or development of choriocarcinoma.
